Registration Online :::

I. Identification
Titel : Dr. Mr. Mrs. Ms.
First name *:    
Middle name *:  
Last name * :    
Institution :
Address * :
City *:    
State : Zip * :
Country :  
E-mail *:  
Telephone: Fax:

Accompanying Person Information  
Title
 Firstname
 Lastname
Title
 Firstname
 Lastname

II. Registration fee
 
Staus
Until 29 Sep 2006
30 Sep 2006 - Onsite
Member
USD 350
USD 400
Non-member
USD 450
USD 500
Trainee
USD 250
USD 300
One Day Nov,2006
USD 200
USD 250
Accompanying
USD 120
USD 150
   
Total(II) USD
 
III. Hotel reservation form Royal Beach Resort , Pattaya
     
Check-in Date
 Arrival Flight
 Time
Check-out Date
 Departure Flight
 Time
Room Type Single Twin Deposit
Mini Suit
120
120
Deposit only one night
USD x room(s)= USD
Executive
140
140
All the room costs :
USD x night x room(s)= USD
     
Total(III) USD
The room costs are net and inclusive of service charge,VAT and Buffet Break fas
     
Total(II+III) USD
 
IV. Sight Seeing, Pre and Post Congress Tours
     
3 Days Bangkok Pre congress Post congress
Sharing Twin
USD 190 x Person(s)= USD
Single Room
 USD 260 x Person(s)= USD
3 Day Ching Mai Pre congress Post congress
Sharing Twin
 USD 165 x Person(s)= USD
Single Room
 USD 210 x Person(s)= USD
3 Day Samui Pre congress Post congress
Sharing Twin
 USD 275 x Person(s)= USD
Single Room
 USD 400 x Person(s)= USD
 
Total(IV) USD
 
Grand Total USD
     
V. Payment
Titel : Dr. Mr. Mrs. Ms.
First name : Last name :
Address
E-mail:
**PAYMENT INFORMATION ================
Payment status :Send your Email:
Subject: SIPS Transaction Response
From: sipsadm@scb.co.th
   

 
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